June 22, 2016

Director's Letter
Carole Baggerly
Director, GrassrootsHealth

Levels of Evidence

Have you ever seen this pyramid of proof before? I want to review it this week, in light of the need to move to the top level! We are ready to add the roof on our pyramid of vitamin D research. The time is now, we can't wait!

This particular pyramid is from a wikipedia article, and medical schools may present them slightly differently, but in general you can see that cell/animal research is the beginning when understanding a problem and changing clinical guidelines is the end goal.
D*action and Protect our Children NOW! are cohort studies and while cohort studies may be lower on the pyramid than RCTs - they are a valid and important part of the scientific cycle when moving research into practice. 
GrassrootsHealth is well known in the scientific and nutriceutical community for its large cohort of vitamin D sufficient participants. You are part of a group of people that has great power. You are a large group together, but represent a population we don't see in any one geography. Reporting on health conditions of such  large group (10,000 participants) with your average serum level (44 ng/ml) has been able to demonstrate some hypotheses that RCTs just haven't been able to do (sometimes because they haven't been able to supplement to the level that is necessary). 
GrassrootsHealth cohort projects
GrassrootsHealth was founded in 2007 and one of its first initiatives was to create D*action, an international health initiative aimed at solving the vitamin D epidemic through vitamin D testing, health tracking and education.
That remains our goal. Below we will present what you have demonstrated with your data in the past 9 years.  We can't wait until everything is known about vitamin D and how it works for particular conditions.  Our group has definitely built a very strong picture of vitamin D safety and ability to be monitored for all.  And, it's inexpensive--if there's any question about taking it, the question should be 'why not!'  Enjoy your day.



Carole Baggerly 
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
What Have You Demonstrated with D*action?

D*action is a world-wide cohort study on vitamin D levels and health outcomes. Many of you participate because you want to know your vitamin D serum level from the comfort of your home, but you might have found even more information to guide your health practices.

A single dose doesn't fit everyone

While average serum level rises with increased intake, there is a wide range of individual serum levels at any given intake amount. You have probably noticed that the supplemental dose you thought would get you to 40-60 ng/ml was not enough. You learned not to give a blanket recommendation to your friends, but instead you tell them they should test their levels to be sure.

It is hard to give a dosage recommendation

The RDA analysis and controversy during spring 2015 gave us reason to look at our data. From your D*action data we computed how much supplementation would get 97% of the population to 40 ng/ml (our minimum recommended level)? We found that to be 10,000 IU/day. An order of magnitude higher than the current RDA.
It is hard to be toxic
You have probably told your doctor that you have increased your supplement level. That you want to get your 25(OH)D above 40 ng/ml. Did your doctors caution you about toxicity?  

While not from D*action, GrassrootsHealth has shared data from a meta-analysis of 23 studies by Hathcock et al., which found that vitamin D toxicity was not reported with supplemental intakes less than 30,000 IU/day or serum levels below 200 ng/ml.

The GrassrootsHealth Scientist Panel recommended range of 40 - 60 ng/ml is well below the 200 ng/ml threshold of toxicity.

You have seen reduced pain with your rise in serum level

Many of you have reported decreased pain with your increased vitamin D serum level. We have been able to report a decrease of 12% in overall pain, but a 20% decrease in back pain.
 You have experienced fewer colds and flu

We have written customer stories about how increases of serum levels have all but alleviated colds/flu. And... the stats have shown us that participants with vitamin D levels ≥40 ng/ml reported 41% fewer cases of the flu and 15% fewer colds compared to participants with levels <20 ng/ml.

Thank you for your continued dedication to spreading the word. Remember to like us on Facebook and join our discussions about vitamin D. 

Paper of the Week

Dr. Cedric Garland
Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention
Cedric F. Garland, et al.
Anticancer Research

Despite the title, the first paper published using data from the D*action cohort is truly a study of our first participants (N=3,667) and their serum levels. The two main conclusions from the paper were:
  1. The tendency for serum 25(OH)D to rise with increasing dosage is much more gradual at higher serum levels than at the lower levels.
  2. There is a very large spread of 25(OH)D values at each intake amount.
This was novel at the time, as many people thought supplementation had a linear relationship to serum level. Also, the wide range of serum levels for every supplement dose had not been previously described.

This data has been instrumental in explaining the need for vitamin D testing and also the need for changing the standard methods of analysis in vitamin D research - to a greater focus on serum level and a reduced focus on dosage.

Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

GrassrootsHealth is respected for the relationship it has with its scientists and for its large group of participants in D*action. As a group, we have power.  We look to you to help spread the word, and you have. We will be relying on you more in the near future - as we need to hit the big goliaths with a newfound force - to try and grab their attention, to elicit change. 
I hope you understand how important your participation is in D*action, that fourth row of the pyramid. Testing every 6 months with D*action and reporting your health outcomes will continue to strengthen our data and is already leading to a change of care -- fully demonstrated with the Protect our Children NOW! project.  (the top level).

Catch up on your testing this week, if you are not current. Your information helps us all. Your contribution (time, money, information) makes a difference in our fight to end vitamin D deficiency.

Have a great week!
Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research Into Practice NOW!
Order Now
Your participation in this project provides information for your answers to D questions and helps fund the GrassrootsHealth projects.

Scientists' Call to D*action
48 international vitamin D researchers join in promoting immediate public health action on vitamin D through achieving serum levels of 40-60 ng/ml.
Updated 8/11/2015

Disease Incidence Prevention Chart
A chart showing the required vitamin D serum levels for prevention of many diseases including cancers, falls, heart attacks and diabetes and several others. 
Updated 8/24/2012

Moving Research into Practice
A summary booklet of key vitamin D research findings by GrassrootsHealth

Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study
Sharon L. McDonnell, et al.
April 2016

Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
October 2015

Incidence rate of type 2 diabetes is >50% lower in GrassrootsHealth cohort with median serum 25-hydroxy-vitamin D of 41 ng/ml than in NHANES cohort with median of 22 ng/ml
Sharon L. McDonnell, et al.
The Journal of Steroid Biochemistry and Molecular Biology
July, 2015

Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
April 2015

Letter to Veugelers, P.J. and Ekwaru, J.P., A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D.
Robert Heaney, et al.
March 2015

Quantifying the food sources of basal vitamin D input
Sharon L. McDonnell, et al.
Journal of Steroid Biochemistry and Molecular Biology
November 2013

Quantifying the non-food sources of basal vitamin D input
Sharon L. McDonnell, et al.
Journal of Steroid Biochemistry and Molecular Biology
November 2013

25-Hydroxyvitamin D in the Range of 20 to 100 ng/ml and Incidence of Kidney Stones
Stacie Nguyen, et al.
American Journal of Public Health
October 2013

A Novel Approach Localizes the Association of Vitamin D Status With Insulin Resistance to One Region of the 25-Hydroxyvitamin D Continuum
Robert P. Heaney, et al.
Advances in Nutrition
May 2013

All-Source Basal Vitamin D Inputs are Greater Than Previously Thought and Cutaneous Inputs are Smaller
Robert P. Heaney, et al.
The Journal of Nutrition
March 2013

Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention
Cedric F. Garland, et al.
Anticancer Research

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